Rafael Nadal’s chronic knee tendinitis seems like old news – these days we’re busy talking about the three Majors he won this year, his career slam and his imminent ascent to GOAThood (just ask Pete Sampras.) But remember that during this very same season Rafa retired in the quarters of the Australian Open because of knee issues and was in visible distress during a match just six months ago at Indian Wells (click here.)
So what’s the secret to this fantastic turnaround? Rafa reportedly underwent a new treatment to his left knee after winning Monte Carlo in late April. After some issues at this year’s Wimbledon, he treated his right knee in the same manner, “to improve the regeneration of the tendon,” Spanish tennis federation doctor Angel Ruiz Cotorro explained. Nadal told reporters that the treatment was too complicated for him to explain in English.
An interview with Rafael Nadal’s knee doctor, Mikel Sánchez was posted on Friday on Spanish sports site Marca.com. (Thanks to FeddyBear for the link!) In it, Dr. Sánchez describes this seemingly miraculous regenerative treatment, which is known as platelet-rich plasma (PRP) therapy. It’s actually surprisingly easy to get the gist, even with Google translate as a filter:
What is the treatment with growth factors?
The mainstay of treatment is very simple to understand. In our body we all have proteins that are plying to the cells to heal injuries. If someone breaks a bone, bone cells know they need to build bone and when to stop because it’s cured. That’s not chance, it’s that there are proteins that stimulate the cells. What we do with this treatment is to concentrate many of these signs on a particular site, which gets them to work many more cells and the speed of healing is much higher and the quality of the scar is better. But there is nothing new. Just as nature does, the focus. What you do is draw a little blood from the patient and treat her to concentrate on many of these growth factors and then put it in the right place.
Here’s another explanation of PRP therapy, without the poor translation factor, via a recent article in Scientific American:
For the treatment, doctors take a small vial of a patient’s blood, about 30 milliliters, and spin it in a centrifuge to separate the platelet-rich plasma from the other components. Then they inject the concentrated platelets at the site of the patient’s injury. In theory, the growth factors that platelets secrete (not including human growth hormone) spur tissue recovery.
According to the SA article, many professional athletes have tried PRP injections, including Tiger Woods after his 2008 knee surgery. James Blake also underwent PRP injections for knee tendinitis this spring, but was feeling pretty lukewarm about the treatment after losing in the first round of Wimbledon. Blake told the pressroom:
You know, whether or not that (PRP treatment) helped, I don’t know. Figured couldn’t hurt. Supposed to get you back on the court quicker. I don’t know if it did.
I mean, I was back in ten weeks. My trainer and other people say that that kind of tendonitis could last a lot longer and could keep going. But I was back and felt good, and basically now, right next to it, another ‑‑ the tendon has been damaged right next to it.
PRP treatment has been controversial for a few reasons. Like Blake, a recent study published in the Journal of the American Medical Association questions its effectiveness, showing that PRP therapy works no better than a placebo when “treating a tricky tendon injury” (click here for more on the study.) And the treatment, though not to be confused with the endurance- boosting “blood doping” that’s plagued the cycling world of late, has a bit of a shady reputation – if only by association. (Click here for an explanation of blood doping vs. PRP therapy) Dr. Anthony Galea, the prominent sports-medicine specialist who administered PRP injections to Tiger Woods and many other professional athletes, was arrested late last year in Toronto for attempting to smuggle Human Growth Hormone across the U.S./Canadian border. According to the New York Times, he was also “suspected of providing athletes with performance-enhancing drugs.”
The World Anti-Doping Agency has been cautious in its approval of PRP therapy, though Dr. Sanchez tells Marca that this attidue is changing (again, via Google translate):
The World Anti-Doping Agency showed some misgivings about the use of plasma rich in growth factors. Why?
There has been a meeting of 20 experts from the IOC in Lausanne, organized by WADA, on growth factors, their use and limits. The unanimous opinion of these experts is that it’s not doping. You can inject a tendon with cortisone if you notify them that you’re doing it. Plasma has been placed in this category – if you use it you have to give notice. But after that meeting we know that WADA is going to remove this rule, because (the treatment) has nothing to do with the increased performance. We hope that it will shortly be approved for free use.
Nadal then had to notify them that he had the injections.
Yes, of course. He has permission and everyone knows that this is not doping. The plasma is what cures the injury, like a plate and screws in a fracture. It can never improve athletic performance.
Through the treatment seems to be working for Rafa, Dr. Sanchez says it’s not necessarily a permanent cure, especially when an athlete’s success is built around intense training and competing for every point:
So Nadal is definitely cured or may lie in the future?
When there is a chronic injury due to (physical) overload, as is the case, we can heal, but he will continue stressing his tendons. He will not change his game, and will not lose games to avoid injury. He will continue at the same rate and there is a risk that his tendons will degenerate again. Therefore we can not say that it is a treatment forever. And it can occur in other tendons, such as the Achilles tendon in the shoulder
Rafa’s back on hardcourts next week, competing in the PTT Thailand Open. Before November’s World Tour Finals in London, Nadal will also play in Tokyo and at the Shanghai Masters.
If all this talk of knee injuries and hardcourts makes you nervous, this photo from Thailand should cheer you up:
Photo by Reuters via Eurosport.